Provider Demographics
NPI:1871534198
Name:GO, CHARITO CHUA (MD)
Entity type:Individual
Prefix:
First Name:CHARITO
Middle Name:CHUA
Last Name:GO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARITO
Other - Middle Name:CHUA
Other - Last Name:GO-VON HENDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:981225 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-1225
Mailing Address - Country:US
Mailing Address - Phone:402-836-9288
Mailing Address - Fax:402-559-8940
Practice Address - Street 1:981225 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5075
Practice Address - Country:US
Practice Address - Phone:402-836-9288
Practice Address - Fax:402-559-8940
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21065208100000X
TXK5960208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102731OtherGROUP PTAN
TX0464885-07OtherIND TPI
OK200823140AMedicaid
TX2035487-02OtherGROUP TPI
TX317142YMNOOtherMEDICARE PTAN
TX8DW142OtherBCBS
TX046488505Medicaid
TX8DW142OtherBCBS